Q. I need a cup or two of coffee in the morning to get me going. My daughter, who follows a strict macrobiotic diet, has been nagging me about my coffee drinking. She contends that caffeine (I only drink caffeinated coffee) is an addictive drug that can cause all kinds of health problems. I have already stopped smoking and am on a strict low-fat diet. Do I really have to give up coffee?
A. Before I answer your question, let me tell you about an experience I recently had. Unbeknownst to me, my secretary decided that caffeine was unhealthy and began bringing me decaffeinated coffee in the morning. For days, I suffered from terrible headaches that nothing seemed to help. Seeing how miserable I was, my assistant finally confessed to what she had done and brought me a cup of real Miraculously, my headaches disappeared and I felt like my energetic self again.
I know from firsthand experience that caffeine is addicting. Although we don’t tend to think of it as such, caffeine is a drug – in fact, it is the most widely used drug in the world. Caffeine is found in foods, including chocolate, and beverages other than coffee, including tea and cola drinks. It is estimated that about 80% of the US population ingests caffeine in some form during the day. Once you begin using caffeine, it is hard to quit. Even moderate caffeine users who abstain from caffeine for even one day will experience withdrawal, including headache, fatigue, and flulike symptoms. This does not mean, however, that caffeine or coffee is dangerous. Even though caffeine is addictive, the amount that is normally found in one or two cups of coffee or tea appears to be harmless. For some, it may even be beneficial. For example, caffeine can improve mental alertness, combat fatigue, and even increase metabolism, which can help burn fat. Caffeine is also an excellent treatment for migraine headache since it dilates the blood vessels in the brain, thus reducing pain. The excessive use of caffeine is an entirely different issue. Too much caffeine – more than four or five cups daily – can cause nervousness, insomnia, aggravate high blood pressure, and even trigger heart palpitations and some people. Although caffeine is a stimulant, a high dose of caffeine over time can have just the opposite effect, especially if consumed with a sugary treat such as a doughnut. Both caffeine and sugar can cause a sudden surge in insulin, a hormone produced by the pancreas, which will put the body into overdrive, resulting in a mid-morning slump.
There have been many studies on the health effects of coffee and some have been extremely negative. For example, in 1981, a highly publicized study linked coffee drinking – with or without caffeine – to a substantially increased risk of pancreatic cancer. Another study linked coffee drinking to bladder cancer. And since there have been anecdotal reports linking caffeine to fibrocystic breast disease, some researchers speculated that it may also increase the risk of breast cancer. More recent studies, however, have not found any relationship between coffee and cancer of any kind. In fact, on closer examination of some of these studies, researchers concluded that coffee drinking was not the culprit, but that cigarette smoking was actually the cause of the increased cancer risk. Smokers drink twice as much coffee as non-smokers, so although it appeared as if people who consume the most coffee have the highest risk of cancer, in reality, the real risk was from their smoking.
Heavy caffeine users, however, do increase their risk of osteoporosis, a major threat for women. Women who drink caffeinated beverages lose more calcium in their urine than woman who abstain from caffeine. In fact, according to the famous Nurses’ Study (conducted by Harvard Medical School investigators who followed every conceivable aspect of the health and habits of over 100,000 nurses for several decades), Women who consumed more than 817 milligrams of caffeine daily (roughly the amount in six to seven cups of coffee) were at three times the risk of suffering a hip fracture. There is some good news to the story, at least for moderate coffee drinkers. Drinking just one glass of milk daily can replace the calcium loss caused by two cups of coffee.
If you drink caffeinated coffee in moderation and are not showing any ill effects, there is no need to stop. I would recommend, however, that you drink a glass of low-fat milk or eat a yogurt daily to restore the lost calcium. I am not, however, giving caffeinated coffee even in small amounts of a clean bill of health for everyone. Pregnant woman in particular should be cautious about caffeine use. Some studies have linked caffeine to delayed conception, premature birth, and fetal growth retardation, although others have not found any link. Even though we do not know for certain whether caffeine is harmful to the fetus, it is advisable for women to avoid it during pregnancy. If you have high blood pressure or a heart condition, it is also wise to reduce your intake of caffeine.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”